MEDICARE: CINDY A SHIRO DO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	156644	MA

General Provider Information

NPI Number	:	1144627308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINDY A SHIRO DO LLC

Provider Business Mailing Address
First Line	:	428 HAMILTON ST
Second Line	:
City	:	SOUTHBRIDGE
State	:	MA
Zip	:	01550-1859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 HAMILTON ST
Second Line	:
City	:	SOUTHBRIDGE
State	:	MA
Zip	:	01550-1859
Country	:	US
Telephone Number	:	508-764-9646
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CINDY A SHIRO
Credential	:	DO
Telephone Number	:	508-764-9646

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	03/02/2015

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